Purpose. Clinician-educator faculty are increasing in numbers in academic medical centers, but their academic advancement is slower than that of research faculty. The authors sought to quantify the magnitude of this difference in career advancement and to explore the characteristics of faculty that might explain the difference. Method. In 1999, a questionnaire was administered to all MD faculty at the rank of instructor and above (259) in the Department of Medicine at the Johns Hopkins University School of Medicine. Results. A total of 180 (69%) faculty returned questionnaires. Of these, 178 identified with one of four career paths: basic researcher (46), clinical researcher (69), academic clinician (38), or teacher-clinician (25). Career path did not differ by age, gender, rank, years on faculty, hours worked per week, family responsibility, or global work satisfaction. After adjusting for age, gender, time at rank, and work satisfaction, the odds of being at a higher rank were 85% less for academic clinicians (odds ratio, .15; 95% confidence interval, 0.06-0.40) and 69% less for teacher-clinicians (odds ratio, .31; 95% confidence interval, 0.11-0.88) than for basic researchers. Clinical researchers did not differ from basic researchers in the likelihood of being at higher rank. Similarly, compared with basic research faculty, the adjusted odds of being more satisfied with progress towards academic promotion were 92% lower for academic clinicians and 87% lower for teacher-clinicians. Conclusions. Clinician-educator faculty were less likely to be at higher rank at this institution than were faculty in research paths. Differences in rank may be explained by lower rank at hire for faculty in these career paths, time available for scholarly activities, or other resources available to support scholarship. Retaining clinician-educators will require further exploration of barriers to promotion inherent to these career paths and methods of modifying these barriers.
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